The state of long-term oxygen therapy

Thursday, June 23, 2011

"The Long Term Oxygen Therapy (LTOT) Conference; Separating Fact From Fiction" held March 31-April 1 in Orlando, Fla., was not like the typical oxygen conference. The objective of this meeting was to focus on the science of LTOT and identify the issues that are impacting effective oxygen therapy in the home. The faculty consisted of some of the most respected pulmonologists and clinicians in the country. The goal was to have an objective review of the current situation in LTOT and discuss what we know, what we don't know and what we must do to change direction in therapy to improve overall outcomes for patients needing LTOT.

Here's a recap of the conference:

Dr. Nick Hill and Dr. Barry Make were conference co-directors. Their presentations established the foundation for the conference by discussing current issues and obstacles in LTOT. Like the Oxygen Consensus Conferences, this meeting came about due to the problems related to more patients needing oxygen and payers reducing reimbursement with the associated impact on products and services. Clinicians have not been actively involved in the assessment, treatment and follow up of patients on LTOT, with the result being patients on home oxygen that may not be oxygenating at all activity levels. The lack of attention to this detail can cost payers more in complications and hospitalizations.

Dr. Hill presented the pathophysiology of chronic hypoxemia to discuss the complications of not oxygenating a patient effectively. The goal of LTOT is to keep patients' oxygen levels at or above the accepted standard at all activity levels. The lack of assessment and follow up for patients on home oxygen equipment could have the patient below acceptable levels (hypoxic) causing complications and co-morbidities. The whole point of LTOT is to prevent these complications--an important reason clinicians should be focused on oxygenation as opposed to equipment.

Dean Hess PhD RRT presented a review of the literature for LTOT. There is strong science for some aspects of LTOT, yet in other areas the science is lacking. The rapid evolution of oxygen products and the changing patient has created a gap in the science that needs evidence. The literature shows that oxygen therapy is effective, yet most of the studies were conducted in a hospital environment with traditional continuous flow products. The new products used today do not have strong evidence of effectiveness and historical research does not set the scientific foundation for these new products or procedures.

Dr. James Stoller presented an overview on the available home oxygen systems. This has been one of the most confusing areas in home oxygen therapy as products have evolved that address the patient's desire for mobility and the payers need to reduce costs. New products have evolved past the traditional continuous flow methods using 99% pure oxygen to intermittent flow delivery with oxygen concentrators producing less than 99% pure oxygen. The combination of lower purity, intermittent flow delivery and patient varying respiratory patterns require the clinicians to be aware and involved in the assessment, prescribing and follow up for patients receiving oxygen in the home.

Dr. Rich Casaburi discussed the challenging question as to whether a patient can be adequately oxygenated 24 hours a day. This is a possibility, yet may not be the reality in today's environment. The combination of patient's ability, available equipment, reimbursement, patient and clinician education, and the overall challenge of focusing on the patients needs at all activity levels makes this a daunting proposition. Dr. Casaburi feels we can do it, yet we need to address the patient oxygenation first, then reimbursement.

Dan Easley and Kim Wiles RRT presented a new model they have developed that focuses on patient oxygenation with the goal of overall reduction in costs. The combination of respiratory therapists focusing on the patients overall healthcare needs in the home with the use of technology and data collection have shown to reduce hospital re-admissions. This is an example of a model for the future with a focus on clinical outcomes as opposed to equipment delivery for homecare providers. The data from their research should help establish an objective reason why hospitals should participate with homecare providers to reduce re-admission.

This conference was unique in that it targeted high-level clinicians to clearly understand the issues in LTOT, which is not about costs or equipment at this time, yet more about clinically effective LTOT. The conference presented why prescribing clinicians need to understand and be involved in the assessment, prescriptions and follow up of LTOT patients to insure we are accomplishing clinical objectives rather than going through the process of just placing oxygen equipment in a patient's home.

Robert McCoy BS RRT FAARC is managing director of Valley Inspired Products.